Ear infections (otitis media)

Most children have had an ear infection by the age of three years. The most common childhood ear infections affect the middle ear. Viruses or bacteria get inside the middle ear and cause an infection or inflammation (swelling). Doctors diagnose ear infections by looking at the ear drum (tympanic membrane).

How do I know if my child has an ear infection?

A middle ear infection often occurs after another illness such as a cold. Along with the usual symptoms of a cold, including fever, sore throat, lack of energy and loss of appetite, children with ear infections often:

• have earaches;

• are irritable (fussy);

• have trouble sleeping;

• tug or pull at their ears; and

• have a lack of response to quiet sounds.

Other symptoms, though less common, are as follows:

• fluid draining from their ears; and

• loss of balance.

How is an ear infection treated?

Almost all middle ear infections in children younger than two years of age are treated with antibiotics. If a child is older than two years and the ear infection isn’t causing too many problems, the doctor may suggest a painkiller, such as acetaminophen, and may reexamine the child two or three days later to see whether he or she needs antibiotics.

Most ear infections are not serious and heal completely. Many antibiotics will treat bacterial ear infections. Your doctor will prescribe one that is appropriate for your child’s condition.

Most children feel better within the first two or three days after starting an antibiotic. But to cure the infection, they must take all the medication prescribed. Your child will probably have to return for another examination so that the doctor can see whether the infection has cleared.

What sort of complications can occur from an ear infection?

Sometimes, fluid may stay in the middle ear for several weeks after the infection has cleared. This may cause temporary hearing loss. Usually, the fluid drains on its own and hearing improves without additional medical treatment. Sometimes, the fluid can become reinfected. If this happens, your child may need to take antibiotics again.

If fluid stays in the middle ear for more than several months, then hearing loss may result. In children younger than three years of age, the fluid can lead to speech and language delay. Sometimes it may be necessary to insert a tube through the ear drum and into the middle ear to drain the fluid. This operation is usually done by an otolaryngologist (ear, nose and throat surgeon). This operation is short in duration and children usually don’t have to stay in the hospital overnight.

When should I call the doctor?

If your child is taking antibiotics for an ear infection, call your doctor if your child:

• still has an earache, even after two to three days of treatment;

• has a fever over 39°C (102°F), or a fever that lasts more than three days;

• is very sleepy;

• is still fussy or cranky;

• is breathing quickly or has trouble breathing; and

• isn’t hearing well.

Can I prevent an ear infection?

Although most ear infections are caused by colds, other factors can make them more frequent. These factors include the following:

• exposure to cigarette smoke;

• using a pacifier (soother);

• bottle feeding while lying down; and

• allergies.

Ask your doctor how to reduce the chance of ear infections in your child, such as through vaccination against pneumococcus, one of the most common bacteria that can cause ear infections.